Abstract:

Objective To evaluate the effect of prone ventilation in children with severe pneumonia at high altitude. Methods By convenience sampling method，80 children with severe pneumonia hospitalized in intensive care department of a tertiary A children’s hospital in Xining，Qinghai Province from June 2021 to June 2023 were selected as the study subjects，and the regional randomization group method was used to divide into a test group and a control group with 40 cases in each group. On the basis of routine care，the test group received prone ventilation once a day for 6 to 12 h；the control group received supine ventilation. Respiratory mechanical parameters（oxygenation index，oxygen saturation，arterial oxygen partial pressure，arterial CO₂ partial pressure），mechanical ventilation duration and safety parameters （incidence of unplanned extubation，stress injury） at 6 h and 12 h of mechanical ventilation were compared. Results There were no shedding cases. The interaction between oxygenation index，blood oxygen saturation and arterial oxygen partial pressure（P<0.05） in the 2 groups was compared（P>0.05）. The results of simple effect analysis showed that at 6 h，the oxygen saturation and oxygenation index in the test group were higher than those in the control group，and the difference was statistically significant（P<0.05）. At 12 h of mechanical ventilation，the oxygenation index，blood oxygen saturation and arterial oxygen partial pressure in the test group were higher than those in the control group，and the difference was statistically significant（P<0.05）. The time of mechanical ventilation in the test group was102.00（60.00，153.00） h and 126.00（108.00，156.00） h in the control group，and the difference was statistically significant（P=0.013）. The incidence of unplanned extubation and pressure injury were compared，and the differences in 2 groups were not significant（P>0.05）. Conclusion Prone ventilation in children with severe pneumonia at high altitude is safe and feasible，which is helpful to improve the respiratory function and shorten the time of mechanical ventilation.

Key words: Pneumonia, Prone Ventilation, High Altitude, Pediatric Nursing

摘要：

目的 评价俯卧位通气在高海拔地区重症肺炎患儿中的应用效果。方法 采用便利抽样法，选取2021年6月—2023年6月在西宁市某三级甲等儿童专科医院重症医学科住院的80例重症肺炎患儿作为研究对象，采用区组随机化分组法，将其分为试验组和对照组，每组各40例。在常规护理的基础上，试验组实施俯卧位通气，每次6~12 h，每天1次；对照组实施仰卧位通气。比较两组机械通气6 h和12 h时的呼吸力学指标（氧合指数、血氧饱和度、动脉血氧分压、动脉血二氧化碳分压）、机械通气时间和安全性指标（非计划性拔管发生率、压力性损伤发生率）。结果 无脱落病例。两组不同时间点氧合指数、动脉血氧分压比较，交互作用均具有统计学意义（P<0.05）；血氧饱和度、动脉血二氧化碳分压比较，交互作用无统计学意义（P>0.05），但血氧饱和度组间效应具有统计学意义（P<0.001）。简单效应分析结果显示，机械通气6 h时，试验组氧合指数、血氧饱和度高于对照组，差异具有统计学意义（P<0.05）；机械通气12 h时，试验组氧合指数、血氧饱和度、动脉血氧分压均高于对照组，差异具有统计学意义（P<0.05）。试验组机械通气时间为102.00（60.00，153.00） h，对照组为126.00（108.00，156.00） h，两组比较，差异具有统计学意义（P=0.013）。机械通气过程中，两组非计划性拔管发生率、压力性损伤发生率比较，差异均无统计学意义（P>0.05）。结论 在高海拔地区重症肺炎患儿中实施俯卧位通气安全、可行，有助于改善患儿的呼吸功能、缩短机械通气时间。

关键词: 肺炎, 俯卧位通气, 高海拔, 儿科护理学